'kqyd :- --------------------------------------- 'kcnksa esa ------------------------------------------ ---------------------------------------------------------- jlhn Ø- --------------------------------------- fnukad -------------------------------------------- glrk{kj 'kqyd fyfid iafmr,l-,u-'kqdyk fo ofo ky;] 'kgmksy ¼e-iz-½ ih&,p-mh- ikb;øe dkslz odz esa izos'k gsrq vkosnu i= fo"k;----------------------------------------------------------------------------- Hkkx &,d ¼01½ 'kks/kkfkhz dk fooj.k Lo;a dh lr;kfir Nk;kfp= 1- vkosnd dk iwjk uke fgunh esa ------------------------------------------------------------------------------------ ¼vaxzsth ds cms+ v{kjksa esa½ ------------------------------------------------------------------------------------ 2- vkosnd dk LFkkbZ irk ------------------------------------------------------------------------------------ 3- i= O;ogkj dk gsrq irk ------------------------------------------------------------------------------------ 4- eksckby ua-@nwjhkk"k Øekad@bZ&esy vkbz-mh- ------------------------------------------------------------------------------------ 5- firk dk uke@ifr dk uke ------------------------------------------------------------------------------------ ¼fookfgr efgyk gksus dh volfkk esa½ ------------------------------------------------------------------------------------ 6- ekrk dk uke ------------------------------------------------------------------------------------ 7- ukxfjdrk ------------------------------------------------------------------------------------ 8- fyax ---------------------------------------------------- 9- jdr lewg --------------------------------------------------------- 10- fo ofo ky; dk uke,oa ukekadu Øekad ------------------------------------------------------------------------------------ 11- ¼d½ ;fn fdlh LFkku@miØe esa dk;zjr~ ------------------------------------------------------------------------------------ gks rks mldk fooj.k ¼[k½ ;fn ¼d½ dh tkudkjh gk gs rks fu;ksdrk ------------------------------------------------------------------------------------ dk vukifr izek.k&i= lyaxu djsaa 12- ¼d½ D;k vkosnd e-iz- dh vuqlwfpr tkfr@ gk @ugh vuqlwfpr tutkfr@vu; finm+k oxz fpduh ijr dks NksM+dj@fnO;kax izoxz ls gsa ¼[k½ ;fn gk rks fdl laoxz ds gsaa ------------------------------------------------------------------------------------ ¼izek.k i= dh Lo;a lr;kfir izfr layxu djsa½
13- vkosnd dh 'ks{kf.kd ;ksx;rk% Ø- ijh{kk dk uke f k{kk cksmz@ fo fo ky; dk uke 1- lsds.mjh @ gkbz Ldwy 10 2- gk;j lsd.mjh 10$2 3- Lukrd 4- LukrdksRrj 5-,e-fQy- 6- usv @ lsv @ LysV o"kz xzsm@ izkirkad izfr kr uksv% dafmdk 13 ls lacaf/kr Lo&vfHkizekf.kr izek.k i= layxu djsaa Js.kh fo"k; 14- fo'ofo ky; }kjk vk;ksftr ih&,pmh- izos'k eksf[kdh ik=rk ijh{kk mrrh.kz gksus laca/kh fo'ofo ky; dh osclkbv ij tkjh lwph ¼ftl ij vkidk uke gks½ layxu djsaa 15- 'kks/k dk;z ds fy;s izlrkfor 'kh"kzd ------------------------------------------------------------------------------------ (Topic of Proposed Research Work) ------------------------------------------------------------------------------------ vxj 'kks/kkfkhz us mdr 'kh"kzd ij dqn 'kks/k fd;k gks rks ------------------------------------------------------------------------------------ mldk fooj.k lfgr izdkf kr 'kks/k i=ksa dh izfr;ka ------------------------------------------------------------------------------------ layxu djsaa 16- D;k vkosnd vu; fdlh mikf/k ds fy;s lalfkkxr@ gk @ ugha vlalfkkxr :i esa bl fo ofo ky; vfkok vu; ------------------------------------------------------------------------------------ fo ofo ky; }kjk vk;ksftr ijh{kk esa ------------------------------------------------------------------------------------ lfeefyr gks jgk gsa ;fn gk ] rks mldk iw.kz fooj.k ------------------------------------------------------------------------------------ fnukad ------------------------------------------------ LFkku -------------------------------------------------- vkosnd ds glrk{kj 2
Hkkx & nks ¼02½ kks/k funsz kd dh lgefr esa] Jh@Jherh --------------------------------------------------------------------------------------------------- ds 'kks/k&funsz'kd ds :i esa 'kks/k dk;z djokus gsrq lgefr iznku djrk gw ] tks ladk; --------------------------------------------------------------- ds fo"k; -------------------------- ---------------------------------------------------------------- ds 'kks/kkfkhz gsaa esaus 'kks/kkfkhz ls 'kks/k ds 'kh"kzd ds laca/k esa folr`r ppkz dh gsa 'kks/kkfkhz us mi;qzdr 'kh"kzd ij 'kks/k dk;z djus dh bpnk O;Dr dh gsa esa fo'ofo ky; ds vf/kfu;e&11 ds varxzr mi;zqdr 'kks/kkfkhz ds 'kks/k&dk;z dk funsz'ku d: xka esjs funsz'ku esa iwoz ls --------------------------------------------------------------------------------- 'kks/kkfkhz iath r gsaa LFkku % ---------------------------------------- 'kks/k funsz kd ds glrk{kj ------------------------------------------------------------- fnukad % -------------------------------------- 'kks/k funsz kd dk uke --------------------------------------------------------------------- in uke ------------------------------------------------------------------------------------------------ irk -------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- bz esy ------------------------------------------------------------------------------------------------- eksckbzy@nwjhkk"k Øekad --------------------------------------------------------------- 3
Fee Rs.... in words......... Receipt No.... Date... Sign. Fee Cleark Pandit S. N. Shukla University, Shahdol (M.P.) Application for Admission in Ph.D. Course Work Programme Subject... PART - I (First) DETAILS OF RESEARCH SCHOLAR Affix Attested Passport Size Photo 1. Full Name of Applicant (Hindi) ------------------------------------------------------ (In English Capital Letters) ------------------------------------------------------ 2. Permanent Address ------------------------------------------------------ 3. Address for Correspondence ------------------------------------------------------ 4. Mobile / Telephone No. / Email ID ------------------------------------------------------ 5. Father's / Husband's Name ------------------------------------------------------ (In case of married woman) ------------------------------------------------------ 6. Mother's Name ------------------------------------------------------ 7. Domicile ------------------------------------------------------ 8. Gender ----------------------------- 9. Blood Group --------------------------------- 10. University Enrollment Number ------------------------------------------------------ 11. (a) If employed anywhere, give details ------------------------------------------------------ (b) If, Yes then enclose N.O.C. ------------------------------------------------------ from employer 12. (a) Does the applicant belong to SC/ YES / NO ST/OBC (Non Creamy Layer/Physically Handicapped) (b) If, Yes then enclose self ------------------------------------------------------ attested certificate 4
13. Educational qualification of applicant - Sl. N o. Name of Examinatio n Educational Board / University Name Year Grade / % of Marks obtai ned Divisi on Subject 1 Secondary / High School 10 2 Hr. Secondary 10 +2 3 Graduation 4 Post Graduation 5 M. Phil 6. NET / SET / SLET Note: Enclose self attested certificates of Point 13. 14. Enclose list of successful candidate's of Ph.D. Entrance Viva-Voce Eligibility Test conducted by the University and published on University Website. 15. Topic of proposed research work -------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------ (If any work done on the proposed topic by the candidate then enclose research paper and give details) 16. Is the applicant appearing in any ------------------------------------------------------ examination for any degree from ------------------------------------------------------ this University or any other University ------------------------------------------------------ then give details ------------------------------------------------------ Date :... Place :... 5 Applicant's Signature
PART - II (Two) CONSENT OF SUPERVISOR I do hereby give my consent to supervise Mr. / Mrs. / Ku. -------------------------------- ---------------------------------------------------------------------------- Research Scholar of faculty ------------------------------------------------------------ Subject ------------------------------------------- I have discussed with research scholar on the proposed topic for research and the scholar is interested to peruse the research work on the above topic. I am willing to supervise the research scholar as research supervisor according to University Act 11. Under my supervision -------------- research scholars are registered. Place ----------------------- Signature of research supervisor ------------------------------- Date ----------------------- Name of research supervisor ------------------------------------ Designation ----------------------------------------------------------- Address --------------------------------------------------------------- --------------------------------------------------------------------------- E-mail ------------------------------------------------------------------ Mobile / Telephone No. ------------------------------------------- 6